Sleep Medicine Essentials E-Book

Teofilo L. Lee-Chiong

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 783

Veröffentlichungsjahr: 2011

Beschreibung

Based on the highly acclaimed Sleep: A Comprehensive Handbook, this is a concise, convenient, practical, and affordable handbook on sleep medicine. It consists of forty topic-focused chapters written by a panel of international experts covering a range of topics including insomnia, sleep apnea, narcolepsy, parasomnias, circadian sleep disorders, sleep in the elderly, sleep in children, sleep among women, and sleep in the medical, psychiatric, and neurological disorders. It serves as an effective Sleep Medicine board examination review, and every chapter includes sample boards -style questions for test preparation and practice.

Leseprobe

CONTENTS

Preface

Contributors

1. Normal Human SleepAnil Natesan Rama, S. Charles Cho, and Clete A. Kushida

Introduction

Adult Sleep Architecture

Sleep In Newborns And Infants

Changes In Sleep With Aging

Sleep Neurophysiology

Autonomic Nervous System

Model Of Sleep Regulation

Key Points

Bibliography

2. Neurobiology of SleepGerald A. Marks

Introduction

Problem Of Definition

Dininc Characteristics Of Sleep And Wakefulness

Nature Of Sleep-Wake Mechanisms

Mechanisms Of Wakefulness

Mechanisms Of Nrem Sleep

Mechanisms Of Rem Sleep

Key Points

Bibliography

3. Physiologic Processes During SleepLeon Rosenthal

Introduction

Circadian And Homeostatic Determinants Of Sleep

Autonomic Chances In Sleep

Cardiac Physiology

Respiratory Physiology

Cerebral Blood Flow

Temperature Regulation

Endocrine Function

Genital Function

Function Of Sleep

Key Points

Bibliography

4. Neuropharmacology of Sleep and WakefulnessEdgar Garcia-Rill, Tiffany Wallace-Huitt, Mark Mennemeier, Amanda Charlesworth, David Heister, Meijun Ye, and Charlotte Yates

Introduction

Connectivity

Blood Flow During Sleep And Waking

Neu Ropharmacology

Key Points

Acknowledgment

Bibliography

5. Insomnia: Prevalence and Daytime ConsequencesW. David Brown

Introduction

Prevalence Of Insomnia

Consequences Of Insomnia

Key Points

Bibliography

6. Causes of InsomniaEdward J. Stepanski

Introduction

Primary Versus Secondary Insomnia

Limitations Of The Secondary Insomnia Model

Theoretical Model For Chronic Insomnia: Predisposing, Precipitating, And Perpetuating Factors

Key Points

Bibliography

7. Evaluation of InsomniaDouglas E. Moul and Daniel J. Buysse

Introduction

Primary Insomnia

Comorbid Insomnia

Demographics

Evaluation Of Insomnia

Assessment Of Chronic Insomnia

Individualized Components Of Evaluation

Differential Diagnosis Of A Presenting Complaint Of Insomnia

Hyperarousal In Insomnia

Evaluation In Relation To Treatment Planning

Key Points

Bibliography

8. Pharmacologic Therapy of InsomniaTeofilo Lee-Chiong and Michael Sateia

Introduction

Hypnotic Medications

Benzodiazepines

Nonbenzodiazepine Benzodiazepine Receptor Agonists

Melatonin Receptor Agonists

Antidepressants

Other Prescription Agents

Nonprescription Hypnotic Agents

Discontinuing Long-Term Use Of Hypnotic Agents

Key Points

Bibliography

9. Nonpharmacologic Therapy of InsomniaMelanie K. Means and Jack D. Edinger

Introduction

Stimulus Control

Sleep Restriction

Sleep Hygiene

Relaxation Therapies

Paradoxical Intention

Cognitive Therapy

Cognitive-Behavioral Therapy

Other Approaches

Effectiveness Of Nonpharmacolocic Therapies

Key Points

Bibliography

10. NarcolepsyRafael Pelayo and Maria Cecilia Lopes

Introduction

Clinical Symptoms

Differences In Clinical Features Between Adults And Children With Narcolepsy

Epidemiology

Pathophysiolocy

Diagnosis

Treatment

Key Points

Bibliography

11. Idiopathic HypersomniaStephen N. Brooks

Introduction

Epidemiology

Clinical Features

Polysomnographic Features

Pathophysiology

Differential Diagnosis

Treatment

Key Points

Reference

Bibliography

12. Posttraumatic and Recurrent HypersomniaCarolyn M. D′Ambrosio and Joshua Baron

Posttraumatic Hypersomnia

Hypersomnia Associated With Mood Disorders

Postinfectious Hypersomnia

Kleine-Levin Syndrome

Idiopathic Recurring Stupor

Menstrual-Related Hypersomnia

Key Points

Disorders Causing Excessive Sleepiness

Bibliography

13. Evaluation of Excessive SleepinessMerrill S. Wise

Introduction

Clinical History And Examination

Conditions Associated With Excessive Sleepiness

Conditions Associated With Chronic Fatigue

Polysomnography

Multiple Sleep Latency Test

Maintenance Of Wakefulness Test

Comparison Of Mslt And Mwt

Key Points

Bibliography

14. Therapy for Excessive SleepinessMax Hirshkowitz

Introduction

Sleepiness In The General Population

Adenosine Antagonism

Sleepiness In The Patient Population

Sleep Disorders Associated With Excessive Sleepiness

Treating Sleepiness In Obstructive Forms Of Sleep-Disordered Breathing

Treating Sleepiness In Narcolepsy And Idiopathic Hypersomnia

Drugs Used To Treat Excessive Sleepiness

Treating Sleepiness In Circadian Rhythm Disorders

Treating Sleepiness In Medical, Neurologic, And Psychiatric Conditions

Treating Iatrogenic Sleepiness

Key Points

Bibliography

15. Adult Sleep-Disordered BreathingReena Mehra and Kingman P. Strohl

Introduction

Clinical Features

Witnessed Apneas

Physical Examination

Clinical Prediction Rules

Polysomnography

Evaluation Of Sleep-Disordered Breathing

Classification Of Respiratory Events

Therapy Of Sleep-Disordered Breathing

Key Points

Bibliography

16. Central Sleep ApneaShahrokh Javaheri

Introduction

Control Of Breathing

Apneic Threshold And The Genesis Of Central Apnea During Sleep

Classification Of Central Sleep Apnea

Physiologic Central Apnea

Eupneic-Hypocapnic (Nonhypercapnic) Central Sleep Apnea

Therapy Of Central Sleep Apnea In Systolic Heart Failure

Hypercapnic Central Sleep Apnea

Central Sleep Apnea In Endocrine Disorders

Central Sleep Apnea With Obstructive Sleep Apnea

Central Sleep Apnea With Upper Airway Disorders

Key Points

Bibliography

17. Obesity Hypoventilation SyndromeJohn G. Park

Introduction

Pathophysiology

Evaluation

Causes Of Chronic Hypercapnia

Therapy

Key Points

Bibliography

18. Cardiovascular Complications of Obstructive Sleep ApneaPeter Y. Hahn, Lyle J. Olson, and Virend K. Somers

Introduction

Physiologic Effects Of Obstructive Sleep Apnea

Mechanisms Linking Obstructive Sleep Apnea And Cardiovascular Disease

Potential Mechanisms Linking Osa And Cardiovascular Disease

Cardiovascular Diseases Associated With Osa

Cardiovascular Diseases Potentially Associated With Osa

Key Points

Bibliography

19. Neurocognitive and Functional Impairment in Obstructive Sleep ApneaW. David Brown

Introduction

Neurocognitive Functioning

Mood

Quality Of Life

Marital Problems

Work And Health

Key Points

Bibliography

20. Positive Airway Pressure Therapy for Obstructive Sleep ApneaMax Hirshkowitz, Teofilo Lee-Chiong, and Daniel Smith

Introduction

Methods Of Determining Optimal Positive Airway Pressure

Positive Airway Pressure Mechanism Of Action

Efficacy Of Cpap In Patients With Obstructive Sleep Apnea

Therapeutic Adherence

Other Modes Of Positive Airway Pressure

Key Points

Bibliography

21. Oral Devices for Obstructive Sleep ApneaDennis R. Bailey

Introduction

Types Of Oral Devices

Indications For Oral Devices

Contraindications For Oral Devices

Available Oral Devices For Sleep Apnea

Oral Devices For Special Circumstances

Function Of Oral Devices

Effectiveness Of Oral Devices

Determining Potential Effectiveness Of Oral Devices

Adverse Effects And Their Management

Key Points

Bibliography

22. Circadian Rhythm Sleep DisordersYaron Dagan, Katy Borodkin, and Liat Ayalon

Introduction

Delayed Sleep Phase Disorder

Advanced Sleep Phase Disorder

Free-Running (Nonentrained) Type

Irregular Sleep–Wake Type

Secondary Circadian Rhythm Sleep Disorders

Evaluation

Key Points

Bibliography

23. Jet LagTimothy H. Monk

Introduction

Definition

Is Eastbound Worse Than Westbound?

Effect Of Aging

Chronic Jet Lag

Jet Lag Countermeasures

Key Points

Acknowledgments

Bibliography

24. Shift Work Sleep DisorderGary S. Richardson

Introduction

Consequences Of Shift Work

Diagosis Of Shift Work Sleep Disorder

Risk Factors For Shift Work Sleep Disorder

Diagnosis Of Shift Work Sleep Disorder

Management Of Shift Work Sleep Disorder

Approach To Patient With Shift Work Sleep Disorder

Key Points

Bibliography

25. Therapy of Circadian Sleep DisordersRobert L. Sack and Kyle Johnson

Introduction

Circadian Science

Phase-Resetting Effects Of Light

Phase-Resetting Effects Of Melatonin

Phase Resetting With Scheduled Rest And Activity

Overriding Circadian System

Homeostat–Circadian Interaction

Clinical Considerations

Patient Instructions For Delayed Sleep Phase Disorder

Patient Instructions For Jet Lag

Key Points

Bibliography

26. Disorders of Arousal and Sleep-Related Movement DisordersKeith Cavanaugh and Norman R. Friedman

Introduction

Disorders Of Arousal

Sleep-Related Movement Disorders

Key Points

Bibliography

27. REM Sleep Behavior Disorder and REM Sleep-Related ParasomniasMaja Tippmann-Peikert, Timothy I. Morgenthaler, Bradley F. Boeve, and Michael H. Silber

Introduction

Rem Sleep Behavior Disorder

Substances Associated With Acute Rbd

Differential Diagnosis Of Rbd

Other Rem Sleep Parasomnias

Key Points

Bibliography

28. Restless Legs Syndrome and Periodic Limb Movement DisorderPhilip M. Becker and Cynthia Crowder

Introduction

Clinical Features

Demographics

Periodic Limb Movements

Primary Versus Secondary Rls

Classification Of Rls

Etiology

Evaluation

Differential Diagnosis

Therapy

Key Points

Bibliography

29. Sleep in Infants and ChildrenStephen H. Sheldon

Introduction

Sleep In Premature Infant

Term Infants: Birth To Two Months

Two To Twelve Months

Two To Five Years

Five To Ten Years

Key Points

Bibliography

30. Obstructive Sleep Apnea in ChildrenPreetam Bandla and Carole L. Marcus

Introduction

Epidemiology

Pathophysiology

Clinical Features

Complications

Evaluation

Treatment

Prognosis

Key Points

Bibliography

31. The Sleepless ChildWilliam H. Moorcroft

Introduction

Early Childhood

Later Childhood

Ineffective Approaches

Key Points

Bibliography

32. The Sleepy ChildGerald Rosen

Introduction

Normal Sleep In A Child

Developmental Changes In The Sleep Of Children

Excessive Sleepiness In Children

Diagnostic Approach To The Sleepy Child

Narcolepsy

Idiopathic Hypersomnia

Sleep Disordered Breathing

Key Points

Bibliography

33. Normal Sleep In AgingLiat Ayalon and Sonia Ancoli-Israel

Introduction

Subjective Reports And Objective Findings

Changes In Sleep Architecture With Age

Other Changes In Sleep With Ace

Circadian Rhythms And Aging

Age-Related Circadian Changes

Effects Of Age-Related Normal Physiologic Changes On Sleep

Physiologic Changes That May Affect Sleep

Age-Related Factors Associated With Sleep Disorders

Primary Sleep Disorders

Importance Of Good Sleep In The Elderly

Key Points

Acknowledgments

Bibliography

34. Aspects of Women's SleepHelen S. Driver

Introduction

Menstrual Cycles

Premenstrual Symptoms And Premenstrual Syndrome

Painful Menstrual Conditions— Dysmenorrhea And Endometriosis

Polycystic Ovary Syndrome

Sleep-Disordered Breathing And Menstrual Cycle

Oral Contraceptives

Pregnancy And Early Postpartum Period

Menopause

Key Points

Bibliography

35. AsthmaDavid A. Beuther and Richard J. Martin

Introduction

Demographics

Pathophysiolocy

Chronotherapeutic Treatment Approaches

Treatment Of Other Contributing Conditions

Key Points

Bibliography

36. Chronic Obstructive Pulmonary Disease and SleepWajahat Khalil and Conrad Iber

Introduction

Pathophysiology Of Copd

Demographics

Evaluation

Consequences Of Respiratory Failure

Effects Of Sleep On Respiratory Failure

Sleep-Associated Oxygen Desaturation

Causes Of Sleep-Associated Oxygen Desaturation In Copd

Chronic Obstructive Pulmonary Disease And Obstructive Sleep Apnea

Effect Of Copd On Sleep Structure

Therapy Of Copd

Key Points

Bibliography

37. Restrictive Thoracic and Neuromuscular DisordersChristophe Perrin, Carolyn DAmbrosio, Alexander White, Erik Garpestad, and Nicholas S. Hill

Introduction

Sleep And Breathing In Normal Subjects

Effects Of Thoracic Restriction On Breathing During Sleep

Assessment Of Breathing During Sleep In Restrictive Thoracic Disorders

Recommendations For Polysomnography In Thoracic Restrictive Disorders

Patterns Of Sleep-Disordered Breathing In Thoracic Cage And Specific Neuromuscular Disorders

Management Of Respiratory Insufficiency During Sleep

Technical Aspects Of Administering Noninvasive Positive Pressure

Ventilators For Nppv

Effect Of Noninvasive And Invasive Positive Pressure Ventilation On Sleep

Monitoring Noninvasive Positive Pressure Ventilation

Key Points

Bibliography

38. Congestive Heart FailureIndira Gurubhagavatula and Emilio Mazza

Introduction

Prevalence Of Sleep-Disordered Breathing In Congestive Heart Failure

Cardiovascular Effects Of Sleep-Disordered Breathing

Treatment Of Sleep-Disordered Breathing And Effects On Congestive Heart Failure

Key Points

Bibliography

39. Sleep and the Gastrointestinal TractWilliam C. Orr

Introduction

Gastroesophageal Reflux

Clinical Manifestations Of Nighttime Castroesophaceal Reflux Disease (Cerd)

Gastric Function During Sleep

Intestinal Motility And Irritable Bowel Syndrome

Key Points

Bibliography

40. Renal DiseaseKathy P. Parker

Introduction

Sleep Complaints

Polysomnocraphic Features

Sleep Apnea Syndromes

Restless Legs Syndrome And Periodic Limb Movement Disorder

Excessive Daytime Sleepiness

Impact Of Sleep Problems

Key Points

Bibliography

41. Endocrine and Metabolic Disorders and SleepAlexandros N. Vgontzas, Slobodanka Pejovic, and George P. Chrousos

Obesity

Diabetes And Insulin Resistance

Insulin Resistance And Sleep Apnea

Reproduction

Hypothalamic-Pituitary-Adrenal Axis

Growth Hormone Disorders: Acromegaly, Sleep Apnea, And Sleepiness

Thyroid Function

Key Points

Bibliography

42. Immunity and SleepJames M. Krueger and Jeannine A. Majde

Introduction

Encephalitis Letharcica And Sleep

Microbial Challenge: What Does It Do To Sleep?

Sleep Loss And Effects On The Immune System

Sleep And Immune Response Modifiers

Does Sleep Help In Combating Infectious Disease?

Key Points

Acknowledgments

Bibliography

43. DementiaMichael V. Vitiello

Introduction

Biologic Bases Of Sleep Disturbances

Interaction Between Biologic Chances And Environmental Factors

Other Causes Of Sleep Disturbance

Symptomatic Treatment Of Insomnia

Nonpharmacologic Therapy Of Sleep Disturbance

Key Points

Acknowledgements

Bibliography

44. Neurodegenerative DisordersDavid G. Harper

Introduction

Causes Of Sleep Disturbance

Consequences Of Sleep Disturbance

Characterization Of Sleep Disturbances

Key Points

Bibliography

45. Parkinson’s DiseaseMichael H. Silber

Introduction

Insomnia

Excessive Daytime Sleepiness

Excessive Motor Activity At Night

Perceptual And Behavioral Abnormalities At Night

Key Points

Bibliography

46. SeizuresMargaret N. Shouse

Introduction

Seizures And Interictal Discharges In Nrem Versus Rem Sleep

Generalized Epileptiform Discharges By Sleep States

Characteristics Of Epilepsy Syndromes

Primary Generalized Epilepsies Of Genetic Or Idiopathic Origin: Awakening Epilepsies

Nonrapid Eye Movement Sleep

Rapid Eye Movement Sleep

Localization-Related Epilepsies: Sleep Epilepsies

Symptomatic Generalized Epilepsies: Sleep And Waking Epilepsies

Sleep Abnormalities

Antiepileptic Drugs

Sleep Deprivation

Key Points

Bibliography

47. SchizophreniaRachel J. Norwood and Teofilo Lee-Chiong

Sleep Disturbance

Polysomnocraphic Features

Specific Sleep Disorders

Dream Content Of Patients With Schizophrenia

Biology Of Sleep Disruption In Schizophrenia

Medication Effects On Sleep In Schizophrenia

Neuroleptic Side Effects On Sleep

Use Of Hypnotic Medication As Adjuncts In Schizophrenia Therapy

Key Points

Bibliography

48. Mood DisordersMelynda D. Casement, J. Todd Arnedt, and Roseanne Armitage

Introduction

Polysomnographic Features

Mechanisms Underlying Sleep Disturbances

Evaluation Of Mood Disorders

Key Points

Bibliography

49. Anxiety DisordersMichael Weissberg

Introduction

Generalized Anxiety Disorder

Panic Disorder With And Without Agoraphobia

Obsessive-Compulsive Disorder

Phobic Disorder

Anxiety In Children

Differential Diagnosis

Biology Of Anxiety

Effect Of Anxiety On Sleep

Treatment

Key Points

Bibliography

50. Alcohol, Alcoholism, and SleepMaren Hyde, Timothy A. Roehrs, and Thomas Roth

Introduction

Effects Of Ethanol On Sleep Of Healthy Normal Persons

Effects Of Ethanol On Sleep Of Insomniacs

Effects Of Ethanol On Sleep Of Alcoholics

Acute Ethanol Abstinence

Sustained Ethanol Abstinence

Key Points

Bibliography

51. Drugs of Abuse and SleepMaren Hyde, Timothy A. Roehrs, and Thomas Roth

Introduction

Stimulants

Analgesics

Hallucinogens

Sedative-Hypnotics

Key Points

Bibliography

52. PolysomnographyNancy A. Collop

Introduction

Digital Age

Filtering

Biocalibrations

Recommended Montage

Key Points

Bibliography

Index

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ISBN 978-0-470-19566-6

PREFACE

Sleep Medicine Essentials is designed with the busy clinician in mind. It can serve both as an independent, practical, and portable book on sleep medicine as well as a complementary compendium to its larger companion textbook, the Wiley Comprehensive Handbook of Sleep Medicine, which has the most extensive coverage of sleep medicine among all the current textbooks in the field. Carefully chosen from the chapters of the Comprehensive Handbook, the topics in this guide provide the essential information that the clinician would need in the day-today management of patients with sleep-related disorders. Thus, whereas the Comprehensive Handbook may be read unhurriedly in the solitude of the medical library or office, this guide can be brought into the clinic, sleep laboratory, or wherever else patients are being cared for.

Advances in the understanding of the complex biology and physiology of sleep and of the various sleep disorders will continue to transform the multidisciplinary science of sleep medicine. As the disciplines of sleep and dreaming evolve, new discoveries will be incorporated in future editions of this book.

I wish to thank the many authors for their excellent chapters and counsel. As with the Comprehensive Handbook, Sleep Medicine Essentials is dedicated to my wife, Dolores Grace Zamudio, and my daughter, Zoë Lee-Chiong.

TEOFILO L. LEE-CHIONG JR.

CONTRIBUTORS

Sonia Ancoli-Israel, Department of Psychiatry, University of California, San Diego and Veterans Affairs San Diego Healthcare System, San Diego, California

Roseanne Armitage, University of Michigan, Ann Arbor, Michigan

J. Todd Arnedt, University of Michigan, Ann Arbor, Michigan

Liat Ayalon, Department of Psychiatry, University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, California

Dennis R. Bailey, Englewood, Colorado

Preetam Bandla, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania

Joshua Baron, Department of Pediatric Neurology, Tufts-New England Medical Center, Boston, Massachusetts

Philip M. Becker, Sleep Medicine Fellowship Program, Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas and Sleep Medicine Associates of Texas, Dallas, Texas

David A. Beuther, National Jewish Health and University of Colorado Health Sciences Center, Denver, Colorado

Bradley F. Boeve, Mayo Sleep Disorders Center and Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota

Katy Borodkin, Department of Psychology, Bar Ilan University, Ramat Gan, Israel

Stephen N. Brooks, Austin, Texas

W. David Brown, Sleep Diagnostics of Texas, The Woodlands, Texas

Daniel J. Buysse, Sleep and Chronobiology Center, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania

Melynda D. Casement, University of Michigan, Ann Arbor, Michigan

Keith Cavanaugh, Rocky Mountain Pediatric Sleep Disorders, The Children’s Hospital, Aurora, Colorado

Amanda Charlesworth, Center for Translational Neuroscience, Department of Neurobiology and Developmental Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas

S. Charles Cho, Stanford Sleep Disorders Clinic, Stanford University, Stanford, California

George P. Chrousos, Pediatric and Reproductive Endocrinology Branch, National Institutes of Health, Bethesda, Maryland

Nancy A. Collop, Johns Hopkins University, Baltimore, Maryland

Cynthia Crowder, Sleep Medicine Fellowship Program, Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

Yaron Dagan, Institute for Sleep Medicine, Assuta Medical Center, Tel Aviv, Israel and Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Carolyn D′Ambrosio, Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts

Helen S. Driver, Sleep Disorders Laboratory, Kingston General Hospital, Departments of Medicine and Psychology, Queen’s University, Kingston, Ontario, Canada

Jack D. Edinger, Department of Veterans Affairs Medical Center, Durham, North Carolina and Duke University Medical Center, Durham, North Carolina

Norman R. Friedman, Rocky Mountain Pediatric Sleep Disorders, The Children’s Hospital, Aurora, Colorado

Edgar Garcia-Rill, Center for Translational Neuroscience, Department of Neurobiology and Developmental Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas

Erik Garpestad, Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts

Indira Gurubhagavatula, Division of Sleep Medicine and the Center for Sleep and Respiratory Neurobiology and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania and Pulmonary, Critical Care, and Sleep Section, Philadelphia VA Medical Center, Philadelphia, Pennsylvania

Peter Y. Hahn, Mayo Clinic College of Medicine, Rochester, Minnesota

David G. Harper, McLean Hospital and Harvard Medical School, Belmont, Massachusetts

David Heister, Center for Translational Neuroscience, Department of Neurobiology and Developmental Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas

Nicholas S. Hill, Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts

Max Hirshkowitz, Baylor College of Medicine, Houston, Texas and Department of Medicine and Department of Psychiatry, Michael E. DeBakey VAMC Sleep Center, Houston, Texas

Maren Hyde, Henry Ford Health System, Sleep Disorders and Research Center, Detroit, Michigan

Conrad Iber, University of Minnesota, Minneapolis, Minnesota

Shahrokh Javaheri, College of Medicine, University of Cincinnati, Cincinnati, Ohio and Sleepcare Diagnostics, Mason, Ohio

Kyle Johnson, Department of Psychiatry, Oregon Health Science University, Portland, Oregon

Wajahat Khalil, University of Minnesota, Minneapolis, Minnesota

James M. Krueger, Washington State University, Pullman, Washington

Clete A. Kushida, Stanford Sleep Disorders Clinic, Stanford University, Stanford, California

Teofilo Lee-Chiong, National Jewish Medical and Research Center, Denver, Colorado

Maria Cecilia Lopes, Stanford Sleep Disorders Clinic, Stanford University, Stanford, California

Jeannine A. Majde, Washington State University, Pullman, Washington

Carole L. Marcus, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania

Gerald A. Marks, University of Texas Southwestern Medical Center, Dallas, Texas and Dallas Veterans Affairs Medical Center, Dallas, Texas

Richard J. Martin, National Jewish Health and University of Colorado Health Sciences Center, Denver, Colorado

Emilio Mazza, Allergy and Pulmonary Associates, Trenton, New Jersey

Melanie K. Means, Department of Veterans Affairs Medical Center, Durham, North Carolina and Duke University Medical Center, Durham, North Carolina

Reena Mehra, Case School of Medicine, Cleveland, Ohio and

University Hospitals Case Medical Center, Cleveland, Ohio

Mark Mennemeier, Center for Translational Neuroscience, Department of Neurobiology and Developmental Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas

Timothy H. Monk, Human Chronobiology Research Program, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

William H. Moorcroft, Northern Colorado Sleep Consultants, Fort Collins, Colorado

Timothy I. Morgenthaler, Mayo Sleep Disorders Center and Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota

Douglas E. Moul, Sleep and Chronobiology Center, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania

Rachel J. Norwood, National Jewish Health, Denver, Colorado

Lyle J. Olson, Mayo Clinic College of Medicine, Rochester, Minnesota

William C. Orr, Lynn Institute for Healthcare Research, Oklahoma City, Oklahoma

John G. Park, Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota

Kathy P. Parker, Nell Hodgson Woodruff School of Nursing and Department of Neurology, Emory University, Atlanta, Georgia

Slobodanka Pejovic, Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania

Rafael Pelayo, Stanford Sleep Disorders Clinic, Stanford University, Stanford, California

Christophe Perrin, Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts

Anil Natesan Rama, Stanford Sleep Disorders Clinic, Stanford University, Stanford, California

Gary S. Richardson, Henry Ford Hospital, Detroit, Michigan

Timothy A. Roehrs, Henry Ford Health System, Sleep Disorders and Research Center, Detroit, Michigan and Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, Michigan

Gerald Rosen, Sleep Disorders Center, Hannepin County Medical Center, Minneapolis, Minnesota

Leon Rosenthal, Sleep Medicine Associates of Texas, Dallas, Texas

Thomas Roth, Henry Ford Health System, Sleep Disorders and Research Center, Detroit, Michigan and Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, Michigan

Robert L. Sack, Department of Psychiatry, Oregon Health Science University, Portland, Oregon

Michael Sateia, Sleep Disorders Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Stephen H. Sheldon, Feinberg School of Medicine, Northwestern University and Sleep Medicine Center, Children’s Memorial Hospital, Chicago, Illinois

Margaret N. Shouse, Department of Neurobiology, UCLA School of Medicine, Los Angeles, California

Michael H. Silber, Mayo Sleep Disorders Center and Center for Sleep Medicine and Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota

Daniel Smith, National Jewish Medical and Research Center, Denver, Colorado

Virend K. Somers, Mayo Clinic College of Medicine, Rochester, Minnesota

Edward J. Stepanski, Accelerated Community Oncology Research Network, Memphis, Tennessee

Kingman P. Strohl, Case School of Medicine, Cleveland, Ohio, University Hospitals Case Medical Center, Cleveland, Ohio, and Department of Veterans Affair Medical Center, Cleveland, Ohio

Maja Tippmann-Peikert, Mayo Sleep Disorders Center and Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota

Alexandros N. Vgontzas, Department of Psychiatry, Penn State College of Medicine, Hershey, Pennsylvania

Michael V. Vitiello, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington

Tiffany Wallace-Huitt, Center for Translational Neuroscience, Department of Neurobiology and Developmental Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas

Michael Weissberg, Department of Psychiatry, University of Colorado School of Medicine, Denver, Colorado

Alexander White, Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts

Merrill S. Wise, Methodist Healthcare Sleep Disorders Center, Memphis, Tennessee

Charlotte Yates, Center for Translational Neuroscience, Department of Neurobiology and Developmental Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas

Meijun Ye, Center for Translational Neuroscience, Department of Neurobiology and Developmental Sciences, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas

1

NORMAL HUMAN SLEEP

Anil Natesan Rama, S. Charles Cho, and Clete A. Kushida

Stanford Sleep Disorders Clinic, Stanford University, Stanford, California

INTRODUCTION

Normal human sleep is comprised of two distinct states, known as nonrapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep is subdivided into four stages, namely stages 1, 2, 3, and 4, which have been recently reclassified to stages Nl, N2, and N3. REM sleep may also be further subdivided into two stages, phasic and tonic.

ADULT SLEEP ARCHITECTURE

NREM Sleep

Nonrapid eye movement sleep accounts for 75–80% of total sleep time:

Stage 1 (Nl) sleep comprises 3–8% of total sleep time. Nl sleep occurs most frequently in the transition from wakefulness to the other sleep stages or following arousals from sleep. In Nl sleep, alpha activity (8–13 Hz), which is characteristic of wakefulness, diminishes and a low-voltage, mixed-frequency pattern emerges. The highest amplitude electroencepha-lography (EEG) activity is generally in the theta range (4—8 Hz). Electromyography (EMG) activity decreases and electro-oculography (EOG) demonstrates slow rolling eye movements. Vertex sharp waves (50–200 ms) are noted toward the end of Nl sleep